A qualitative analysis of caregiver perceptions of pediatric dental surgery under general anesthesia.

BACKGROUND: Dental surgery under general anesthesia (GA) is a common treatment for severe childhood caries and thus may serve as an event to motivate behavior change. The frequency of recurrent caries, however, indicates opportunities within current practice to change a child's oral health behaviors. AIM: To assess caregiver experiences related to their child's dental surgery to inform development of a behavioral intervention. DESIGN: Semi-structured interviews with caregivers of children receiving GA for dental surgery. Transcripts (n = 19) were analyzed using qualitative thematic methods. RESULTS: Children were 2-5 years of age, mean 3.8 years. Limited access to GA services was a source of caregiver frustration and a barrier to caries treatment. Surgical events elicited emotional reactions including guilt, anxiety, and a sense of caregiver accountability for development of severe caries. There was variation in caregiver awareness and/or motivation to change oral health behaviors. CONCLUSIONS: A child's dental surgery under GA is an emotionally challenging event yet may inspire hope and expectations for improvement. Surgery offers an opportunity to implement interventions at a time when caregivers may be open to assistance with behavior change, though stress and anxiety may create barriers. Behavioral interventions should be tailored to individual caregiver needs/barriers and stage of developmental readiness.

Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors.

Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.

A qualitative study of tobacco dependence treatment in 19 US dental hygiene programs.

INTRODUCTION: The US Public Health Service calls for health professionals to provide tobacco dependence counseling for patients. The purpose of this study was to understand how dental hygiene programs make decisions about and provide training for tobacco dependence counseling to help them graduate more fully competent hygienists. METHODS: We conducted interviews (N = 32) with mainly program and clinic directors from 19 US dental hygiene education programs for this qualitative case study. We explored fluoride therapy training and tooth whitening training for comparison. Two analysts summarized the transcripts into a case study for each program. RESULTS: All programs reported a similar process of learning about and choosing a method for teaching the topics explored. The programs used a common process, ADPIE (assess, diagnose, plan, implement, evaluate), to structure students'clinical encounters. Almost all programs train students to ask about tobacco use and to advise quitting, but few programs train students to effectively help patients to quit and only 2 programs evaluated the competence of all students to provide such training. ADPIE shows promise for integrating tobacco dependence treatment more fully into the clinical training of dental hygiene students. Comparison to tooth whitening and fluoride therapy training indicated that complexity of the treatment and alignment with dental hygiene's mission were themes related to training decisions. CONCLUSION: Full implementation of tobacco dependence counseling into dental hygiene education requires a commitment by dental hygiene educators to train students and faculty in counseling techniques and their evaluation. We identified an existing clinical structure as showing promise for facilitating improvement.

A case of collegial communication and a patient who does not pay.

Four individuals who teach ethics in dental schools comment on a case in which negative financial information is revealed by one dentist when transferring records of a potential patient to another dentist. All commentators find varying degrees of ethical problem with disclosing such information. Professional codes discourage this practice. All commentators stress the importance of the potential new dentist developing a relationship based on professional standards, with the greatest emphasis placed on the patient's health needs. Several of the commentators discuss positive ways of conducting a patient interview, including specific useful language.

Evaluation of a Near-Infrared Light Transillumination Device for Caries Detection in Interproximal Primary Molar Surfaces.

Purpose: To evaluate the sensitivity and specificity of the near-infrared light transillumination caries detection method by using DEXIS CariVu (DCV) for imaging of interproximal primary molar surfaces (IPMS).
Methods: A retrospective evaluation of patient records at a university pediatric dentistry (PD) clinic identified 22 patients with unrestored IPMS, which had images of both bitewing radiography (BW) and DCV. A scoring system (no caries, incipient caries, dentinal caries) was developed for the study. Two investigators (pediatric dental faculty) identically scored 90 IPMS in both BW and DCV images, establishing benchmark IPMS scores. The 180 images were then compiled in a randomized order in a questionnaire, which was answered by 24 raters (PD residents and faculty) using the study caries scoring system. Data analysis included raters and experts' percent agreement, Vassar Stats for sensitivity and specificity, and Kendall's correlation coefficient for interrater reliability.
Results: The overall agreement between raters and experts for DCV images was 48 percent (54 percent for no caries, 23 percent for incipient caries, and 68 percent for dentinal caries). The DCV's sensitivity and specificity to detect any caries were, respectively, 0.72 and 0.54, 0.60 and 0.53 for incipient caries, and 0.82 and 0.53 for dentinal caries. The BW's sensitivity and specificity to detect any caries were respectively, 0.82 and 0.87, 0.98 and 0.86 for incipient caries, and 0.99 and 0.87 for dentinal caries. The overall interrater reliability was 0.48 (95 percent confidence interval equals 0.46 to 0.50).
Conclusion: The use of DCV as a stand-alone caries detection method for IPMS is limited.

Improving the effectiveness of tobacco use cessation (TUC).

This paper includes an update of a Cochrane systematic review on tobacco use cessation (TUC) in dental settings as well as narrative reviews of possible approaches to TUC and a more detailed discussion of referral for specialist TUC services. On the basis of these reviews we conclude that interventions for tobacco users in the dental setting increase the odds of quitting tobacco. However, the evidence is derived largely from patients using smokeless tobacco. Pharmacotherapy (such as nicotine replacements, bupropion and varenicline) is recommended for TUC in medical settings but has received little assessment in dental applications, although such evidence to date is promising. Whether the dental setting or referral to specialist TUC services is the most effective strategy to help people to quit tobacco use is unclear. An effective specialist service providing best available TUC care alone may not be the answer. Clearly, such services should be both accessible and convenient for tobacco users. Closer integration of specialist services with referrers would also be advantageous in order to guide and support oral health professionals make their referral and to maximise follow-up of referred tobacco users. Future research direction may consider investigating the most effective components of TUC in the dental settings and community-based trials should be a priority. Pharmacotherapy, particularly nicotine replacement therapy, should be more widely examined in dental settings. We also recommend that various models of referral to external and competent in-house TUC specialist services should be examined with both experimental and qualitative approaches. In addition to overall success of TUC, important research questions include facilitators and barriers to TUC in dental settings, preferences for specialist referral, and experiences of tobacco users attempting to quit, with dental professionals or specialist services, respectively.

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals.

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

The relationship of dental visits to parental knowledge of management of dental trauma.

PURPOSE: The purposes of this study were to: (1) determine the level of parental knowledge regarding initial trauma management; and (2) assess which factors could influence that level of knowledge. METHODS: A self-administered questionnaire was given to parents of patients that attended 1 of 2 dental clinics. The questionnaire consisted of 3 parts and assessed patient and parental demographics and knowledge of dental trauma management. RESULTS: Four hundred sixty-seven questionnaires were completed. Most patients had Medicaid insurance (79%). Most parents would seek care from a dentist (71% broken tooth; 62% avulsed tooth). Only 31% knew that avulsed permanent teeth could be placed back into the socket, and only 25% of parents chose milk as a transport medium for avulsed teeth. A mere 3% of parents answered all 5 trauma management questions correctly, and 10% had no correct responses. The number of correct responses was not affected by clinic location, history of previous trauma, sex, education, or insurance status. Parents of recalled patients had more correct responses (P<.05). CONCLUSION: Knowledge of dental trauma management was poor. The fact that parents of recalled patients were somewhat more knowledgeable suggests that the dental visit can be an effective vehicle for education. The management of dental trauma should be part of the dental health education provided at dental visits.

Comparing Case-Based with Team-Based Learning: Dental Students' Satisfaction, Level of Learning, and Resources Needed.

The aims of this study were to compare third-year dental students' satisfaction and level of learning in case-based learning (CBL) versus team-based learning (TBL) and the resources required in those two methodologies. Level of learning was assessed for both knowledge and application, and resources were defined as student and faculty time and rooms. In academic year 2018-19, all 68 third-year dental students in one U.S. dental school were enrolled in two sequential semester-long courses; the first used CBL, and the second used TBL. After each course, students and faculty facilitators completed surveys, and data from students' knowledge and application exams were collected. The student surveys asked students to report their satisfaction with the learning methodology (CBL or TBL); the faculty surveys asked the faculty facilitators to report the resources used for each methodology. Forty-five of 68 students (66%) consented to participate; however, a larger number of students completed surveys in the two semesters (69% for CBL and 87% for TBL). Fourteen of 16 (88%) faculty facilitators completed the CBL survey, and five of the six (83%) completed the TBL survey. Overall, the results showed that students' satisfaction was higher with CBL than TBL (Mann-Whitney U = 882.0; p<0.001), and students reported having a better understanding of concepts after CBL than TBL (U = 899.0; p<0.001). The students performed better on knowledge exam items in TBL than CBL (86% vs. 82%) but the same on application items (both 86%). Resource requirements for both methods were extensive, with TBL requiring fewer facilitators and rooms than CBL but requiring more time from both students (2.6 vs. 2.3 hours weekly) and faculty members (2.3 vs. 1.4 hours weekly). In this study, students preferred CBL to TBL but had higher knowledge scores in the TBL course. The resources needed for both CBL and TBL were said to be extensive, with infrastructure use higher for CBL but time for students and faculty higher for TBL.

Survey of oral health knowledge and behavior of pregnant minority adolescents.

PURPOSE: This study's purpose was to compare dental visits and oral health knowledge of African American (AA) and Hispanic American (HA) pregnant adolescents in a community health clinic. METHODS: Demographics, oral health knowledge, oral hygiene, and dental visits during pregnoncy were surveyed by anonymous questionnaire to adolescents who were pregnant at the time of the study or within the last year. RESULTS: Responses from 50 AA and 61 HA adolescents between 12 and 20 years old were analyzed. Fourteen percent of AAs and 26 percent of HAs saw a dentist during pregnancy, while 26 percent of AAs and 16 percent of HAs reported regular 6-month visits when not pregnant. Fifty-two percent of AAs and 43 percent of HAs knew that oral health problems could affect the pregnancy or growth of the baby. Thirty-four percent of AAs and 56 percent of HAs knew that pregnancy was related to gum problems (P = .02). Logistic regression revealed the predictors of a dental visit during pregnancy, including living with a boyfriend/husband (P = .02, odds ratio = 4.4, confidence interval = 13-153) and dental visits when not pregnant (P < .001, OR = 13.6, CI = 3.7-50.5). CONCLUSIONS: Minority pregnant adolescents had only limited dental visits whether or not they were pregnant and possessed limited knowledge of oral health and pregnancy outcomes.

Understanding Oral Health Behaviors Among Children Treated for Caries Under General Anesthesia.

Purpose: To identify factors that influence oral health behaviors in the pediatric population treated for caries under general anesthesia (GA).
Methods: Nineteen semi-structured key informant interviews were conducted with caregivers while their children received comprehensive dental care under GA. Interviews were recorded on audio and professionally transcribed. Transcripts were coded using an inductive approach, with codes categorized and themes identified in an iterative process among four investigators.
Results: Data from 14 English and five Spanish interviews were reported. Factors that impacted accessing dental services, toothbrushing, and sugar intake were related to experiences living with severe caries and family dynamics. Many caregivers found the process of accessing care challenging, with barriers ranging from a caregiver's denial of disease severity to insurance status and provider availability. Discordant dynamics between parents and their children hindered efforts to change oral health behaviors. Stress of daily life impacted the ability for some caregivers to prioritize oral health.
Conclusion: Our findings provide a better understanding of how a family's experiences and dynamics prior to dental care under GA can serve as barriers to changing oral health behaviors within an urban, Medicaid-enrolled population. Future work should address the complexity and context of familial interactions in efforts to improve surgical outcomes.

Benefits and Challenges of Partner Site Engagement with Community-Based Dental Education Programs: The Partner Sites' Perspectives.

The aim of this qualitative study was to examine the perspectives of key personnel at partner sites providing community learning experiences to dental students to gain more understanding of the effects that community-based programs have on the sites themselves. Fourteen semi-structured interviews were conducted in 2015 with individuals from nine extramural sites. Interviewees had a range of roles from clinicians to CEOs, with six also reporting they were faculty preceptors. Three of the researchers developed a coding scheme focused on the benefits and challenges that community sites experience from participating in a community-based dental education (CBDE) program. Each coder then reviewed the interview transcripts independently before final group discussions and recoding to agreement. The main themes related to benefits were recruiting future dentists, staying current with clinical developments, sites' indirectly improving their missions by exposing students to broader roles of oral health providers, raising awareness regarding the need for dentistry in community settings, and nurturing a positive workplace environment. The main themes related to challenges were balancing education and training for students with clinical demands, communication with the university, and managing distinctive clinical and professional characteristics of students. This study's participants reported that the main benefit of CBDE for partner sites was dentist recruitment. The study also provided insights for both partner sites and dental schools to consider when developing and maintaining these partnerships.

Timing of Case-Based Discussions and Educational Outcomes for Dental Students.

The aim of this study was to determine if the timing of a case-based discussion affected dental students' assessment scores. The study specifically investigated whether the timing of a 60-minute case-based discussion before or after a 90-minute lecture affected students' performance on a quiz on topics in pediatric dentistry. In addition, students' preferences for the timing of the case discussion and confidence in the material with different timings were assessed in a survey. In a crossover design, all 52 second-year students in fall 2016 at one U.S. dental school participated in a case-based discussion either before or after lectures on stainless steel crowns and pulp therapy, compared to a control unit on space maintenance with no case-based discussion. The students took quizzes and responded to questionnaires a week after the lectures. A total of 45 (87%) of the 52 students consented to have their scores used. The results showed that the students performed better on the quiz when participating in a case-based discussion after the lecture compared to the discussion before the lecture (after mean=6.1±0.8 vs. before mean=5.5±1.3). The students' control quiz mean following a lecture with no associated case discussion was 6.3±0.8. Students also expressed more confidence when the case was held after the lecture (12.7 vs. 11.6, p=0.02) and preferred the case after (p=0.01). This study found that higher quiz and confidence scores resulted when a case discussion was held after (vs. before) a lecture. When dental educators consider adding a case discussion to a lecture format as a method of increasing students' active learning, these results suggest that having the case discussion after the lecture may be more effective for learners new to the material.

Pediatric oral health knowledge of African American and Hispanic of Mexican origin expectant mothers.

PURPOSE: This study assessed the impact of a lecture on children's oral health knowledge of pregnant women from vulnerable African American (AA) and Hispanic of Mexican origin (HM) populations utilizing the same urban community health center prenatal education program. METHODS: Participants heard one 45-minute lecture in English or Spanish on children's oral health, and completed a survey (English or Spanish) before and after the lecture. RESULTS: Seven sessions provided 60 participants: (a) 30 AA; and (b) 30 HM. These two groups differed on: (1) educational attainment; (2) preferred language; (3) country of origin; and (4) baseline scores. They were similar in: (1) age; (2) frequency of first mothers; and (3) final scores. Oral health knowledge significantly rose from baseline to the end of the lecture (ANOVA, P < .001). Educational attainment was associated with HM baseline scores (P = .04), whereas age was associated with AA final scores (P = .01). CONCLUSIONS: An oral health lecture within a prenatal program improved oral health knowledge for African American and Hispanic of Mexican origin pregnant women, though associated factors varied between the two groups. Further study is needed to explore long-term knowledge retention and effect on the future babies' oral health.

Association Between Childhood Traumatic Stress and Behavior in the Pediatric Dental Clinic.

PURPOSE: The purpose of this study was to examine the relationship between a history of potentially traumatic events (PTE) and a child's behavior during dental treatment. METHODS: Parents of healthy children, age four years and older and attending their initial dental appointment at a university pediatric dental clinic, were asked to complete the Traumatic Events Screening Inventory-Parent Report Revised and a demographic survey. Following the dental appointment, a pediatric dental resident reported the child's behavior using the Frankl scale. RESULTS: A total of 170 parent-child pairs participated; 53 percent of parents indicated their child had experienced at least one PTE; 44 percent reported their child had a prior negative experience at the dentist. Adjusted multivariable logistic regression analysis showed no significant association between PTE history and poor dental behavior (P=0.994), but a significant association was observed between a previous negative dental experience and poor dental behavior (P=0.000) as well as between age (younger than five years old) and poor behavior (P=0.006). CONCLUSIONS: Children with a history of potentially traumatic events did not exhibit uncooperative behavior more often than those who did not. A previous negative dental experience and the child's young age were significantly associated with uncooperative behavior.

The views of dentists, nurses and nutritionists on the association between diabetes and periodontal disease: a qualitative study in a Latino community.

OBJECTIVE: To interview health professionals in a Latino community about the association between diabetes and periodontitis, and provide a basis to develop interventions for them to promote oral health and good glycemic control among patients with diabetes. METHODS: Five dentists, seven nurses and two nutritionists were interviewed about their practices relevant to oral health and diabetes, knowledge about the association, beliefs about Latinos, recommendations on reaching others in their fields, and barriers. The interviews were audiotaped, transcribed, and analyzed qualitatively. RESULTS: Professionals identified policy, community and practice barriers for promoting diabetic control and oral health. CONCLUSIONS: Producing a resource list, cross-educating professionals about diabetes and oral health, training professionals to better serve Latino patients, developing appropriate protocols for each profession regarding the association between diabetes and periodontitis, and educating the community about diabetic control, oral health and disease prevention were identified as potential strategies to improve oral health among Latino persons with diabetes.

A chairside aid for shared decision making in dentistry: a randomized controlled trial.

The concept of shared decision making (SDM) is an important emerging trend in clinical medicine but has received little or no attention in the dental literature. Decision aids can play a useful role in SDM by helping patients and clinicians choose among reasonable alternative treatment options. The purpose of this study was to develop and test an Endodontic Decision Board (EndoDB) for chairside use to help clarify treatment alternatives, benefits, risks, prognosis, and costs when root canal therapy or extraction of a tooth was indicated. The hypothesis was that the use of the EndoDB would lead to improved patient knowledge, greater satisfaction with the decision-making process, and no difference in anxiety when compared to the standard discussion and informed consent process (usual care). The EndoDB was tested in a randomized controlled trial in a postgraduate endodontics clinic. After treatment discussion, a brief questionnaire was completed by the patient to measure knowledge, satisfaction, and anxiety. Patients in the EndoDB group (n=32) demonstrated a small, but statistically significant, increase in knowledge (t-test; difference=+0.37; p=0.03) compared to the usual care group (n=35). There was no difference between groups in the measures of satisfaction or anxiety (Mann-Whitney U-test; p>0.05). Decision aids may emerge as a useful tool to facilitate SDM and evidence-based clinical practice.

Dental and medical students' knowledge and opinions of infant oral health.

Primary care providers' involvement with and perceptions of the epidemic of early childhood caries could be related to attitudes and knowledge of the disease as well as to differences in discipline-based recommendations. A cross-sectional survey of demographics, opinions on infant oral health care visits and importance of infant oral health care, knowledge of tooth eruption, and knowledge of health care guidelines of the American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD) was administered by several methods to first- and fourth-year dental and medical students at two University of Illinois campuses. Some expected variations were found among dental and medical students pertaining to perceptions and knowledge of infant oral health. Higher proportions of dental students responded correctly or considered the issues very important. However, Rockford medicine students were more likely to know when children should be weaned, yet less likely to agree with recommendations for time of first dental visit. Furthermore, fourth-year dental students were less likely than first-year dental students to give the recommended answer for age of first dental visit. Variances of opinions and basic knowledge of infant oral health of dental and medical students showed inconsistencies with desired outcomes of educational and clinical experiences. Further research is needed to understand the role of experience and other factors to effectively educate primary care providers in this area.

Toothbrushing patterns over time in at-risk metropolitan African-American 5th- 8th graders.

OBJECTIVES: A large study of risky pre-teen behavior provided an opportunity to examine self-reported toothbrushing frequency for stability over time and adequacy. METHODS: 1115 metropolitan African-American children at risk for violence and drug use self-reported toothbrushing frequency in at least one of five measurement points from 5th to 8th grade as part of a larger study. Longitudinal data were available for 815 students. RESULTS: 81% reported mainly twice daily, 8% reported mainly once daily, 10% changed over time, and 1% were consistently less than once daily. CONCLUSIONS: Overall, the children reported once or twice daily toothbrushing frequency, stable between 5th and 8th grades. A minority of children showed low or inconsistent frequencies and these results may indicate an opportunity for intervention to improve habits.

Specialty and sex as predictors of depression in dentists.

BACKGROUND: Stress, burnout, substance abuse and suicide among dentists have been studied, yet no study in the United States has specifically addressed depression in e dentists. The objective of the authors' study was to determine if sex and dental specialty were correlated with depression in dentists. METHODS: The authors conducted a survey of a sample of dentists chosen randomly from the American Dental Association's mailing list of member dentists. The survey, stratified by sex and specialty, resulted in 560 responses, for a 53 percent response rate. The authors used the Zung Self-Rating Depression Scale to measure depression. The authors examined the respondents' sex, age, number of children, marital status, specialty, practice type, location of practice, years in practice and hours worked per week. RESULTS: The rate of depression in the overall sample was 9 percent. Sex was associated with depression (P < .001), but specialty was not. However, multiple regression analysis found that sex was significantly related to depression in only two specialties: periodontics and pediatric dentistry. Overall, the regression model explained an unimpressive 6 percent of the variance in depression scores. The most important finding of the study was that only 15 percent of depressed dentists were receiving treatment. CONCLUSIONS: The survey results showed that only female pediatric dentists and periodontists were more depressed than their male counterparts. None of the other variables studied contributed significantly to the understanding of depression in dentists. Depressed dentists, like other depressed people, tend not to seek treatment. CLINICAL IMPLICATIONS: Depression and serious depression occur among dentists, and much of it is untreated. Because depression is harmful to dentists and raises quality-of-care issues, they should be educated to help them recognize depression and encouraged to seek treatment.